Poor women who delay breast cancer treatment less likely to survive

It stands to reason that the longer a woman waits to start breast cancer treatment, the worse her prognosis. A new study of California women puts some hard numbers on the cost of delaying treatment – and finds that Latinas, African Americans and poor women were most likely to put their recovery at risk by waiting six weeks or more to have surgery or begin chemotherapy.

Researchers from UC Irvine and Children’s Hospital of Orange County focused on breast cancer patients between the ages of 15 and 39. Women in this age group account for only 5% to 6% of all breast cancer patients, but their cancers are typically more aggressive, and the urgency to begin treatment is higher.

Using data from the California Cancer Registry database, the research team identified 8,860 women who were diagnosed between 1997 and 2006. Records in the database showed which women began treatment within two weeks of diagnosis and which women waited at least six weeks to get their treatment underway.

Here’s what they found:

* 22% of women who delayed their treatment for at least six weeks were not alive five years after their diagnosis. That compares with 16% of women who began treatment within two weeks of diagnosis and 17% of women who got started within two to four weeks.

* Nearly 18% of women with a low socioeconomic status, or SES, delayed their treatment for at least six weeks, compared with 8% of women with a high SES. Perhaps as a result, 28% of the low SES women died within five years, compared with only 11% of the high SES women.

* In a related finding, 18% of women with no health insurance or who were insured through a public program like MediCal waited at least six weeks to begin treatment, and 31% of them died within five years. Among women with private health insurance, only 10% delayed their treatment for at least six weeks, and 14% died within five years.

* When the researchers considered the race, ethnicity, insurance status and SES of the women all at the same time, they found that the five-year survival rate was lowest for African American women (57%), followed by Latinas (74%), Asian Americans (81%) and whites (86%).

The results were published online Wednesday by the journal JAMA Surgery.

"Surgical delay time was a significant risk factor for reduced survival after breast cancer diagnosis independent of race/ethnicity, cancer state at diagnosis, age, insurance type, and SES," the researchers concluded. "It may be difficult for a physician to make arrangements for surgery because of barriers such as a patient’s lack of insurance."

However, an invited critique that was also published by JAMA Surgery said the data were sliced and diced in so many ways that it’s hard to say with great confidence that treatment delay can be singled out as a culprit.

"In the end, in this analysis, we have continued evidence of disparities in healthcare that lead to decreased survival, whether the disparity is a function of race, income, or delays in receiving treatment," wrote Dr. Leigh Neumayer of the University of Utah School of Medicine in Salt Lake City. "We should all work on eliminating these disparities in an effort to improve the health of our nation."

You can read a summary of the study online here and the critique here.